I am a physician, financial planner, educator, and I love to tell great stories. The world is too complicated and doesn’t have to be that way. The goal for this blog is to bring simplicity to the two subjects I know best – financial planning and medicine.
My background - Med School at University of Mississippi and residency at the Medical College of Virginia. I taught at the University of Florida and worked in various emergency departments in the Jacksonville area.
In trying to find a financial planner, I went back to school for fun and found another passion. I founded Life Planning Partners, Inc. in 2004 and felt like I haven’t had a job since. I began sharing stories on the interplay of my two professions and am grateful for audiences all over the country who want to hear my message about medicine, money, and keeping it simple. Please join the conversation.

Is Obamacare a Government Takeover of Medicine?

The purpose of this blog is to educate non-policy wonks on the content of the Affordable Care Act, discuss the practical logistics of how the law will be implemented, and share my perspective on potential “good” and “bad” of the law. The law is far from perfect, but it is the most significant attempt our country has ever made at reforming our costly and inefficient health care system. In case you are a reader who thinks the entire law is “bad,” I implore you to learn about the ten sections of the law in this previous post.

In addition to speaking gigs, I also do “talk radio” about once a month. The questions I’m asked give some indication of where education on the ACA is lacking. One refrain I’ve heard over and over is that Obamacare is a “government takeover” of medicine. This post explores that concept.

“Government takeover” fears seem to take on several different variations.

Medicine will be a government run entity – doctors will be employed by the government and care will be paid for by the government.

All of the doctors will be employed by the government, but insurance companies will still exist.

The government will dictate what doctors can and cannot do.

The government will make it so onerous to practice medicine that everyone will quit.

If the government has one iota of involvement in any form, it is a government takeover.

So what really happens with the Affordable Care Act? The “government” currently pays about 43% to 46% of all healthcare costs, mainly through Medicare, Medicaid, and the armed services. When Obamacare is fully implemented, it is expected this amount will increase to 49.2%. It is a clear increase, but nowhere near a 100% government-paid program. The private sector will still be responsible for over half of healthcare spending.

How about practice systems? How will the government control this? Most countries pick one payer/provider system and stick with it. Right now, our country has four health care systems:

Government provided/government paid – this is the VA Health System, the armed services, and the Indian Health Service. Doctors in these systems are employees of the government and will stay that way under health care reform. There are many complaints with these institutions, but there are also many satisfied patients. This will not change under health care reform.

Privately provided/government paid – this is Medicare and Medicaid. Many patients are okay with Medicare and those on Medicaid are glad they have something. Doctors don’t like these programs so much because the pay isn’t great and the Medicare/Medicaid watchdogs notoriously look for a reason to not pay the doctor’s fee. Doctors can refuse to participate in these programs, so it technically isn’t government control.

Privately provided/privately paid – this is “regular” insurance. Most people are okay with their regular insurance, but aren’t very happy when it costs a lot of money or when the insurance company denies payment for care they received. Insurance companies in the group market (i.e. employer plans) are required by the government to insure everyone, regardless of health. If not required, insurers would certainly choose to cover only healthy people in order to make more money. In the individual market, insurance companies in most states are not required to insure sick people. Under the ACA, this will change. Insurers will be required to sell insurance to anyone who can pay for it. This requirement would be new government involvement, but comparable to the group insurance market.

Self-insured – these are the roughly 40 million or so people who either cannot afford coverage, choose to go without coverage, or have pre-existing conditions which make it impossible to get coverage. The uninsured are at the mercy of a patchwork volunteer system that is inefficient and expensive to run. Some of the current programs to cover the uninsured are funded by the government (taxpayers) and some through charity (benevolent taxpayers), but the majority of the uninsured are left to fend for themselves. Requiring that people obtain coverage and assisting the low income uninsured in paying for that coverage is part of the Affordable Care Act. This is greater government involvement – making people take responsibility, and assisting individuals in fulfilling that responsibility.

One of the failures of the ACA is that we took a very expensive and complex health care system, and made it more complex. This is the reason that overhead for our health care system is about 30% of the cost of health care. Most countries pay only 5% to 10% overhead because of the efficiencies of one system. Had our legislators attempted that coup, it would have definitely been a government takeover.

Post Your Comment

Post Your Reply

Forbes writers have the ability to call out member comments they find particularly interesting. Called-out comments are highlighted across the Forbes network. You'll be notified if your comment is called out.

I find it sad that I have to use that headline, but that is exactly how it is presented to me when people ask me about reform. I try to educate those that have no idea what reform is really about, and it takes being on their turf to do it.

One things left our of this article: The Catholic Institutions (7,000 plus schools, 400 hospitals, all Catholic charities, Catholic Universities such as Notre Dame must either close their doors or sin against their Catholic beliefs/laws. Obama conveniently forgot about Separation of Church & State.

I think it is amusing that the Catholic Bishop was scheduled for some time to close out the Republican Convention, but when the Dems heard this they quickly got him to close out their convention. Afraid of losing Christian votes, Obama?

Catholics, learn about this Obama Mandate which will mean government control over religion in this country, then go to the polls and vote with your conscience.

A few months ago I spent 2 days in critical care unit of a catholic hospital- Providence Hospital (Sisters of Providence) I paid quite a bit of money for those 3 days. They own a large amount of land here in Anchorage and they have been expanding at a furious rate. At least 10 new buildings in the last couple of years. This takes a lot of money (our money). I know people who couldn’t afford the care and were given deep discounts or free care. That is fine, but if they are going to charge the rest of us outrageous amounts of money they can’t tell us that they will sell us one service but not another. They allow only so many hospital beds per a thousand people so the hospitals have a virtual monopoly. Unless other hospitals are allowed to open to offer the services that people need and want then the existing ones should be required to provide these services.

Ridiculous. My wife worked for a Catholic hospital in Tampa in the mid-90′s, and their healthcare covered birth control. It wasn’t an issue.

Why has it become an issue now? Likely because it’s politically expedient.

Separation of Church and State means that the State is not supposed to promote or have a bias towards a particular religion. That religion does not have the right to force it’s views on people outside of its religion. Is your argument that if the Catholic Church bought a franchise of McDonald’s Restaurants, that they could alter the healthcare plan of the employees due to the church’s views? That’s insane.

What if it were a church that… hmm… didn’t accept minorities? Would they go to court saying they have a right not to serve minorities in their businesses because “it’s a sin”??

Ask Sarah Palin how well abstinence works. And the Church is the Church not a medical provider. Last time I checked the hospitals in my area pay taxes. I don’t want your religion being involved in health care decisions.